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Open Access Research article

The impact of secondary hyperparathyroidism on the efficacy of antiresorptive therapy

Gyöngyvér Kincse1, József Varga2, Péter Somogyi3, Péter Szodoray4, Péter Surányi1 and János Gaál1*

Author Affiliations

1 Department of Rheumatology, ‘Kenézy Gyula’ Hospital, Bartók Béla út 2-26, H- 4032, Debrecen, Hungary

2 Department of Nuclear Medicine, University of Debrecen, Medical & Health Sciences Centre, Debrecen, Hungary

3 Department of Orthopedic Surgery, University of Budapest, Budapest, Hungary

4 Institute of Immunology, Rikshospitalet, Oslo University Hospital, Oslo, Norway

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BMC Musculoskeletal Disorders 2012, 13:244  doi:10.1186/1471-2474-13-244

Published: 10 December 2012

Abstract

Background

The aim of the present study was to assess whether the efficacy of bisphosphonate treatment is influenced by PTH levels measured in newly diagnosed osteoporotic patients and to identify the threshold value, beyond which PTH level negatively influences therapeutic efficacy.

Methods

One hundred and thirty-eight osteoporotic patients were enrolled into the study. All subjects underwent laboratory screening, bone densitometry with DEXA, and x-ray imaging. The changes in bone density were evaluated after a mean follow-up period of 13.37 ± 1.29 months. Correlation analysis was performed on the clinical data of patients, the percentage changes of BMD values, and the PTH levels measured at the beginning of study, using SPSS software.

Results

The mean age of the subjects was 64.82 ± 10.51 years, and the female-to-male ratio was 116/22. Baseline BMD value measured with AP DEXA scanning was 0.854 ± 0.108 g/cm2 in the L1-4 vertebrae and 0.768 ± 0.115 g/cm2 in the left femoral neck. By the end of the follow-up period, these values changed to 0.890 ± 0.111 g/cm2 and 0.773 ± 0.111 g/cm2, respectively. We found a statistically significant, negative correlation between PTH levels and the percentage changes of lumbar BMD values measured at the end of the follow-up (correlation coefficient R2 = 0.121, p < 0.0001). The analysis of frequency histograms suggested that negative effects on bone might be expected above a PTH level of 60 pg/mL (7.3 pmol/L).

Conclusion

Our findings imply that a baseline PTH level over 60 ng/mL can reduce the efficacy of bisphosphonate treatment.

Keywords:
D vitamin status; PTH level; Antiresorptive therapy; Efficacy